Androgen-deprivation regimen for multiple bone metastases of extramammary Paget disease

Conflicts of interest: none declared. Sir, Extramammary Paget disease (EMPD) with distant metastases has a poor prognosis because in most cases the disease does not respond to any treatments. Castration, antiandrogen drugs and luteinizing hormone‐releasing hormone (LH‐RH) agonist, in various combinations, have been developed as an androgen‐deprivation therapy for prostate cancer. The therapy has demonstrated superior efficacy, similar to that of hormone therapy in breast cancer, without serious adverse effects. Recently, expression of the androgen receptor (AR) has also been identified in EMPD,1, 2 suggesting that androgens may be involved in its pathogenesis. We present the first case of multiple bone metastases in a patient with EMPD which were successfully treated by an androgen‐deprivation regimen. A 65‐year‐old Japanese man with an erythematous plaque in the pubic region (Fig. 1a) was referred to us in September 2001. Biopsy revealed large cells with clear cytoplasm, invading the dermis. The tumour cells stained positively with periodic acid–Schiff (PAS) reagent after diastase digestion. A diagnosis of EMPD was made. The skin lesion was excised with a 3·0 cm margin and the right inguinal lymph nodes were dissected. Metastases were found in two of nine lymph nodes.